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General NPI Number Information
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NPI Number | 1578763579
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Entity Type | Organization
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Legal Business Name | ADVANCED ORTHOTICS AND PROSTHETICS TECHNOLOGIES LLC
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 07/27/2007
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Provider Practice Location Address
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Address Line | 133-135 SOUTH ST.
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City | DANBURY
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State | CT
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Zip | 06810
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Country | US
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Telephone | 203-798-7616
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Fax |
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Provider Business Mailing Address
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Address Line | 12 FAWN RIDGE DR
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City | BROOKFIELD
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State | CT
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Zip | 06804-3803
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Country | US
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Telephone | 203-740-8952
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY MICHAEL VAN HOOF II
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Credential | C.P.O.
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Telephone | 203-740-8952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | CPO 1530
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License Number State | CT
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